SGLT2 inhibitor versus carbohydrate-restricted isocaloric diet: reprogramming substrate oxidation in type 2 diabetes.

OBJECTIVE: Based on the whole-body energy metabolism and insulin action, the difference between increased excretion of carbohydrate in urine by SGLT2i and reduced same amount of oral carbohydrate intake are scarce. This study aimed to compare the effect of carbohydrate availability with reduced oral intake (carbohydrate-restricted isocaloric diet: CRIC diet) or lost in urine, as urinary glucosuria on sodium/glucose cotransporter-2 inhibitor (SGLT2i) treatment, focus on the insulin requirement and the macronutrient oxidation within insulin treated type 2 diabetes. METHODS: This is randomized 3-arm open-label prospective study. Subjects treated with titrated basal-bolus insulin regimen subsequent to three diet regimens, control diet (CON), administration of canagliflozin 100 mg/day to CON (SGLT2i), or CRIC diet, with a week admission to the endocrinology ward followed by 12 weeks outpatients' management. The main outcome measures including the total insulin dose (TID) required to achieve euglycemia, fasting and postprandial energy expenditure (EE) and respiratory quotient (RQ) at 1-week and 12-week. RESULTS: We enrolled 23 patients with type 2 diabetes (male/female: 14/9, age: 53.6 ± 14.2 years, body mass index: 26.9 ± 4.8 kg/m2, HbA1c: 12.5 ± 1.6%). The TID was similar with CON and SGLT2i at both 1 and 12-weeks. Although comparable net carbohydrate availability in SGLT2i and CRIC groups, the TID was significantly higher in the CRIC (p = 0.02) compare to the SGLT2i at both 1 and 12-weeks. Fasting EE was similar in all groups, postprandial EE was significantly elevated in the SGLT2i and CRIC groups compared to the CON group (p = 0.03 and 0.04). Compare to the CON, lower basal fasting RQ (p = 0.049) and decreased delta-RQ (postprandial RQ/fasting RQ) indicated continuous lipid substrate utilization in the SGLT2i (p = 0.04) and CRIC (p = 0.03) groups. CONCLUSION: The CRIC diet resulted in a similar fasting and postprandial EE and substrate oxidation compared to the SGLT2i. The increased insulin requirement in the CRIC diet indicates that a relatively highly lipid and protein consumption, compared to the SGLT2i and CON, may influence insulin requirement.

Validation of improved 24-hour dietary recall using a portable camera among the Japanese population.

BACKGROUND: The collection of weighed food records (WFR) is a gold standard for dietary assessment. We propose using the 24-h recall method combined with a portable camera and a food atlas (24hR-camera). This combination overcomes the disadvantages of the 24-h dietary recall method. Our study examined the validity of the 24hR-camera method against WFR by comparing the results. METHODS: Study subjects were 30 Japanese males, aged 31-58 years, who rarely cook and reside in the Tokyo metropolitan area. For validation, we compared the estimated food intake (24hR-camera method) and weighed food intake (WFR method). The 24hR-camera method uses digital photographs of all food consumed during a day, taken by the subjects, and a 24-h recall questionnaire conducted by a registered dietitian, who estimates food intake by comparing the participant's photographs with food atlas photographs. The WFR method involves a registered dietitian weighing each food item prepared for the subject to consume and any leftovers. Food intake was calculated for each food group and nutrient using the 24hR-camera vs. weighed methods. RESULTS: Correlation coefficients between the estimated vs. weighed food intake were 0.7 or higher in most food groups but were low in food groups, such as oils, fats, condiments, and spices. The estimated intake of vegetables was significantly lower for the 24hR-camera method compared to the WFR method. For other food groups, the percentages of the mean difference between estimated vs. weighed food intake were -22.1% to 5.5%, with no significant differences between the methods (except for algae, which had a very low estimated intake). The correlation coefficients between the two methods were 0.774 for energy, and 0.855, 0.769, and 0.763 for the macronutrients, proteins, lipids, and carbohydrates, respectively, demonstrating high correlation coefficients: greater than 0.75. The correlation coefficients between the estimated vs. weighed for salt equivalents and potassium intake were 0.583 and 0.560, respectively, but no significant differences in intake were observed. CONCLUSIONS: The 24hR-camera method satisfactorily estimated the intake of energy and macronutrients (except salt equivalents and potassium) in Japanese males and was confirmed as a useful method for dietary assessment.

Validity of Visceral Fat Area Measurement by Bioelectrical Impedance Analysis in Japanese Obese Individuals.

INTRODUCTION: Obesity management is a critical global issue. It is essential to evaluate visceral adiposity which is associated with metabolic syndrome and cardiovascular disease. AIM: This study aims at precisely evaluating the necessity of visceral adipose tissue in obesity management. METHODS: We assessed the validity of visceral fat area (VFA) measurement using bioelectrical impedance analysis (BIA) with computed tomography (CT) as a reference in obese subjects. Although VFABIA exhibited significant correlation with VFACT, the difference between VFACT and VFABIA increased with an advancing degree of obesity. RESULT AND CONCLUSION: The BIA device seemingly underestimated VFA in obese subjects compared with the normal-weight subjects.

1.55-µm high-peak, high-average-power laser amplifier using an Er,Yb:glass planar waveguide for wind sensing coherent Doppler lidar.

We have developed a high-gain, high-peak-power laser amplifier at an eye-safe 1.55 µm wavelength using an Er,Yb:glass planar waveguide for wind sensing coherent Doppler lidars (CDLs). Our planar waveguide is free from stimulated Brillouin scattering and realizes high gain thanks to its multi-bounce optical-path configuration. A peak power of 5.5 kW with a pulse energy of 3.2 mJ is achieved at the repetition frequency of 4 kHz, which leads to an average power of 12.8 W. The gain is more than 23 dB. The wind sensing at more than 30 km is demonstrated with a CDL using the developed amplifier.

Associations of Low-Intensity Resistance Training with Body Composition and Lipid Profile in Obese Patients with Type 2 Diabetes.

Resistance training to increase muscle mass and functional capacity is an integral part of diet and exercise programs for the management of obesity and type 2 diabetes. Low-intensity resistance training with slow movement and tonic force generation (LST) may be a practical and safe regimen for elderly obese individuals but the health benefits are uncertain. This study investigated the effects of LST on body composition and metabolic parameters in obese patients with type 2 diabetes. Twenty-six obese patients with type 2 diabetes engaged in LST training during hospitalization and were advised to maintain this regimen for 12 weeks after discharge. We compared lipid profile, arterial stiffness, and body composition before and after LST training. After 12 weeks of LST training, the ratio of lower extremity muscle mass to body weight increased significantly (0.176 ± 0.028 to 0.184 ± 0.023, mean ± SD), while body fat mass and body fat percentage decreased significantly (36.2 ± 10.9 kg to 34.3 ± 9.4 kg and 41.2 ± 8.6% to 40.1 ± 7.7%, respectively). Moreover, high-density lipoprotein cholesterol was significantly increased (42.2 ± 14 mg/dl to 46.3 ± 12.4 mg/dl) and both free fatty acids and lipoprotein(a) were decreased (665.2 ± 212.1 µEq/l to 525.4 ± 231.3 µEq/l and 15.4 ± 18 mg/dl to 13.8 ± 18 mg/dl, respectively). No significant change was observed in arterial stiffness. Although this study was a non-controlled investigation and some confounding factors including dietary intake, medication and compliance with training might affect the study result, a brief (12-week) LST training program may be a safe and effective strategy for the management of obesity and type 2 diabetes.

Effect of LCDs displaying blurred images on the postural control system.

In order to evaluate display devices, a geostationary image and the character were generally used in previous studies. We have proposed a new method for comparing the standing posture when a subject views a liquid crystal display (LCD) displaying a movie scrolling from the left to the right. In this study, we mathematically measured the degree of determinism in the dynamics of the sway of center-of-gravity. The Double-Wayland algorithm was used as a novel method. As a result, the dynamics of the sway when subjects viewed the movie as well that of the sway in the resting state was considered to be stochastic. The moving map task would not change it into a deterministic one.

[An attempt to prevent lifestyle-related diseases of schoolchildren in collaboration with parents, schools and communities].

PURPOSE: The authors focused on preventing lifestyle-related diseases among schoolchildren on the basis of health surveys with blood examinations and questionnaires on lifestyle in collaboration with parents, YOGO teachers, and public health nurses. The present study purposed to evaluate this approach using the PRECEDE-PROCEED Model. METHOD: The authors inquired of schoolchildren's parents their awareness of their children's health through health surveys of their children. Additionally, changes in the role of YOGO teachers and public health nurses before and after our attempt were assessed. The significance and problems with our approach were then evaluated based on the PRECEDE-PROCEED Model. RESULTS: Based on the PRECEDE-PROCEED Model, it was clarified that, for prevention of lifestyle-related diseases among schoolchildren, health surveys with blood examinations and questionnaires on lifestyle increased parents' interest in their children's health. On the basis of the results of health examinations, the role of YOGO teachers changed from leading figure for general health education to supporters of health promotion for individuals, with provision of health education classes in schools for this purpose. The role of public health nurses also changed from providing health education at the request of schools to supporting families to improve their lifestyle, including that of their children. CONCLUSIONS: In collaboration with children's parents, YOGO teachers and public health nurses, the present approach to prevent lifestyle-related diseases of schoolchildren on the basis of health surveys has advantages for increasing interest in schoolchildren's health, and should be useful for health promotion.